Going into the community The project has several components. An online screening questionnaire has been created so women can see if they are at risk and what options they might have. There are also face- to-face encounters with residents at community events and through the outreach work of the NGOs, because a more active approach may be needed to identify women nearing the borderland of psychosis. Peers will also be trained to reach out to their neighbours. Participants who display signs of illness are provided with options for treatment. Those with obvious signs, such as depression, will be directed to see a doctor, but for those with early symptoms of mental illness, Professor Chen’s group is offering psychological interventions in the hope that this can forestall the need for medication. Women at a very early stage of illness will be offered ‘coaching’ to help them deal with Early intervention for patients suffering from psychosis can be a matter of life and death. In 2013, research by Chair Professor Eric Chen Yu-hai in the Department of Psychiatry showed that young people aged 15 to 25 who received early intervention had a 62 per cent reduced risk of suicide and 46 per cent fewer suicide attempts. Findings like this gave impetus to a major Jockey Club-funded project to trial early intervention in older adults who were not being served. Now, Professor Chen is directing his expertise to a group that has been falling through the cracks: women from economicallydeprived backgrounds. “A good metaphor is a river that floods. We have seen vivid photographs of people living downstream who pile up sandbags to try to keep the water away. What we are hoping to do is go to the source of the problematic river and identify and correct the potential problems before they go downstream.” The project is being piloted in Kwai Tsing, Tsuen Wan and Sham Shui Po and is expected to run for several years. Professor Chen plans to do a randomised control trial of those receiving cognitive behavioural training and those receiving the usual support from social workers and mental wellness centres to see what difference the therapy makes. This will provide evidence for extending the model to the rest of Hong Kong. having less education and their cognitive function was more affected,” Professor Chen said. Given these circumstances, he and his team launched a programme in May, 2018 that is reaching out to raise awareness, identify women at risk and intervene before they even develop psychosis. Three NGOs are partners in the pilot project – Caritas, New Life (a mental health NGO) and Hong Kong Federation of Women’s Centres – and other organisations, such as ethnic minority groups, migrant groups and the Department of Health, will also be involved. anxiety, work problems, family strife and the like and mobilise their own resources. Women who are at a later stage but who have not yet developed psychosis will be offered cognitive behavioural therapy, which has been shown internationally to be effective. The latter group may be more difficult to identify, so help is being sought from ‘gatekeepers’ such as NGO visitors, family and friends. Holding back the flood The women will also be encouraged to engage in physical exercise such as yoga, which was shown in earlier research by Professor Chen’s group to improve cognitive function, a particularly important consideration for women in economically-disadvantaged groups. “We are not talking about just managing and treating somebody earlier and better. We are talking about preventing somebody from getting ill in the first place,” Professor Chen said. Women tend to develop psychosis from their late 20s and 30s onwards, unlike men who tend to develop it in their late teens and early 20s. This suggests that external factors, such as stressful life events or living conditions, may play an important role in the onset of their disease. “When we looked at the data from our last project, we found that for women whose household income was below the median, on top of financial difficulties they had more stressful events happening to them, such as significant physical illness or a family member being ill. They also had the disadvantage of Psychosis tends to strike women a decade or longer after men. The Department of Psychiatry has a new project that builds on its deep, long-term work and helps the most economically-deprived female sufferers treat this silent ailment as early as possible. A GENDERED APPROACH TO MENTAL HEALTH We are not talking about just managing and treating somebody earlier and better. We are talking about preventing somebody from getting ill in the first place. Professor Eric Chen Yu-hai Speakers and representatives from the collaborating organisations at the press conference on the survey of Hong Kong stressful life events and life satisfaction. Earlier research by Professor Chen’s team has shown that engaging in physical exercise such as yoga could improve cognitive function. It is a particularly important consideration for women in economically-disadvantaged groups. Knowledge Exchange 37 | 38 The University of Hong Kong Bulletin | November 2018
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